2.09 Ultraviolet Keratoconjunctivitis (Welder's or Tanning Bed Burn)

Presentation

The patient arrives with burning eye pain, usually bilateral, beginning 6 to 8 hours after a
brief exposure without eye protection to a high intensity ultraviolet light source such as a
sunlamp or welder's arc. The eye exam shows conjunctival injection; fluorescein staining may
be negative or show diffuse superficial uptake (discerned as a punctate keratopathy under slit
lamp examination). The patient may also have first-degree skin burns.

What to do:

Instill an antibiotic ointment and patch eyes for approximately 12 hours. Cold compresses,
rest, and analgesics (oxycodone, codeine, ibuprofen, naproxen) should be prescribed
to control pain. The first dose can be given in the ED.

Warn the patient that pain will return when the local anesthetic wears off, but that the
pills prescribed should help to relieve it.

What not to do:

Do not give the patient a topical anesthetic for continued instillation. It can slow healing
and increases the risk of eye injury.

Do not be stingy with pain medications. This is a painful, albeit short-lived injury.

Discussion

The history of a brief exposure may be difficult to elicit after the long asymptomatic
interval. Longer exposures to lower intensity UV sources may resemble a sunburn. Some
physicians find it quite acceptable to substitute for the antibiotic ointment a one-time
instillation of an ophthalmic anesthetic ointment (Tetracaine), which allows longer-lasting
topical anesthesia. Some patients do not tolerate bilateral patching (they may have to get
home alone). Cold compresses may be substituted for patches. Healing should be complete
in 12-24 hours. If the patient continues to have discomfort, an ophthalmologist should be
consulted.